Monday, July 11, 2011

HIV screening in the emergency department [peer review]

Every year, tens of thousands of Americans living with HIV pass through the health care system with their infections undetected and thus unaddressed. This is a big problem for these patients. This is a big problem for HIV prevention, too.

Hospital emergency departments provide one largely untapped opportunity to detect HIV infection. Yet the obstacles to doing this are great. Patients arriving for a broken bone or a rash don’t necessarily want to be tested. There isn’t much time or privacy to conduct the testing in many settings. It’s not easy to effectively link patients to HIV care.

Annals of Emergency Medicine published a special supplement with a series of studies on this topic. I was involved in two studies, Torres, et al, and Hsieh, et al. Two thoughts for readers to ponder from my experiences in the first study, which involved site visits to six EDs around the country:

First, a simple yardstick of cost-effectiveness is given by the cost per previously-undiagnosed detected case. Across most of the sites, this number was about $10,000. Second, the prevalence of new detected cases was uncannily similar across the sites: About 1% of patients tested.

Are you surprised by either of these numbers? Are they large or small, compared with what you otherwise expected? How should one judge?

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